Unconscious man with “Do Not Resuscitate” tattoo causes problem at a hospital


Tattoos used to be an uncommon and distinctive form of body modification, however, it seems like pretty much everyone has one these days. Plenty of people would argue that it’s rarer not to have a tattoo than to have one and while tattoos used to mean or represent something, people now get them for a host of reasons, including for a joke.

This light-hearted approach to tattoos led to doctors having an ethical dilemma after a man’s “do not resuscitate” tattoo caused mass confusion in a Miami emergency doctors.

The 70-year-old man was unconscious when he arrived at the emergency room, and given his elevated blood-alcohol level, he was extremely drunk. His pulse began to slow at a worrying rate and the doctors decided that they needed to save him. However, due to the amount of alcohol in his system, the man couldn’t be roused – although, that wasn’t terribly unusual.

“Unfortunately, we get a lot of that kind of patient at my hospital,” said Dr Greg Holt, one of the doctors who treated the man.

DNR tattooCredit: The New England Journal of Medicine

While the man’s condition may not have been unique, his tattoo was. Such was the confusion that the ink caused, Holt and his entire team of eight were called down to the emergency room to see what was going on.

The man had the words “do not resuscitate” tattooed across his chest, with a line under the word “not” for emphasis.

“We always kind of joked around about doing that. A lot of physicians say “Boy, I’m going to have that tattooed on my chest so everyone knows my status.” Then you see it and…holy crap,” says Dr Holt.

The first thing the team needed to decipher, was the legality of the tattoo. Tattoos are not legally-binding DNR orders and Dr Holt says that there are very specific requirements for legal orders in Florida.

For example, in order for paramedics and emergency officials to honour a DNR, “it has to be on yellow paper,” says Holt. For any DNR to be legally binding, “both the doctor and the patient have to have signed it… but it doesn’t say anything about tattoos.”

People who want DNR’s have to fill out forms with their doctors then “DNR” will appear on their medical charts.

The patient’s blood pressure began to dip dangerously low and Dr Holt and his team decided that it was best to keep the man alive. They supplied him with IV fluid, antibiotics and “some medications to keep his blood pressure up, which some people would consider resuscitation,” says Dr Holt. “If I knew that he was no code, I would have put him on a breathing machine,” Dr Holt adds.

The danger with a tattoo is, “I always kind of thought people might regret it later on, you get drunk, you get it when you were a kid, you wish you didn’t, but what can you do?” says Dr Holt.

The hospital ethics team arrived to consult with the doctors, and they came to the conclusion that the tattoo more than likely did represent the patient’s true wishes. According to Holt, the placement of the tattoo also mattered. “It was exactly where you would have to do chest compression, the guy had to have had some knowledge of the medical system,” he says.

“One way is to say ‘we don’t know [his wishes] so forget [the tattoo]’. The other way is to say we are being too dogmatic,” continued Dr Holt.

Two hours later, it emerged that the man hand signed a DNR order and the tattoo was correct. The patient then took a turn for the worse and the doctors decided to let him go, but it was a wake-up call to Holt and his team.

“It’s a concern for both physicians and patients because you want to do right by someone and if you don’t know, you do everything you can think of because we always pick the reversible choice, not the one you can’t take back when faced with uncertainty,” he says.

I imagine that when you’re a doctor, every bone in your body naturally wants to save that patient’s life. So to stand there and be unsure of what you are meant to do must’ve been absolutely frightening to Dr Holt and his team. With the rise in tattoos, it might be best to bring in some new legislation regarding DNR’s.